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BackgroundEndovascular strategies have been used to manage patients with thrombosed vascular access for hemodialysis. We analyzed primary success rate and patency rates of balloon angioplasty following mechanical thrombectomy for the treatment of thrombosed native arteriovenous fistulas.MethodsThis was a retrospective study of 24 patients with thrombosed native arteriovenous fistulas who were referred for treatment in the intervention unit of the Radiology Department. All patients had been performed percutaneous thrombo-aspiration and balloon angioplasty. Technical and clinical success rates as well as the 6th and 12th months primary and secondary patency of fistulas were evaluated.ResultsTechnical and clinical success was 83%. In the 6 of 20 patients, early re-thrombosis were detected. Patent AVF with primary and secondary patency rates at 6 and 12 months was 55%-40%. The secondary patency rates at 6 and 12 months were 75% and 70%.ConclusionMechanical thrombectomy with balloon angioplasty is a minimally invasive and effective procedure for the treatment of thrombosed native arteriovenous fistula. Advantages of this technique are minor complication rates, cost effectiveness, high technical success rate.

The aim of the present study was to evaluate resistive index (RI) in the feeding artery of the functioning and dysfunctioning arteriovenous fistulas (AVFs). Measurement of RI in the feeding artery using Doppler ultrasound was performed in 48 patients on hemodialysis. Twenty-seven upper arm AVFs and 21 radiocephalic AVFs were studied. The patients were categorized into three groups according to clinical function: group 1, AVFs with normal function (n = 21); group 2, AVFs with abnormal clinical function (reduced pump flow) (n = 20); and group 3, AVFs with abnormal clinical function (increased venous pressure) (n = 7). Resistive index measurements and morphologic changes were compared between functioning and dysfunctioning AVFs. Increased RI values were detected in the AVFs with reduced pump flow. The average RI values of feeding artery were 0.47 +/- 0.07 in group 1, 0.67 +/- 0.18 in group 2, and 0.49 +/- 0.05 in group 3. Two brachial artery aneurysms, one brachial artery pseudoaneurysm, ten venous stenoses, and six venous thromboses were detected in the AVFs with diminished pump flow (18/20 patients, 90%). Both increased RI values and vascular complications were detected by Doppler ultrasound in the patients with reduced pump flow during dialysis. This study shows that Doppler ultrasound examination of AVF feeding artery may provide useful data on morphologic and functional characteristics of AVF.